Provider Demographics
NPI:1609947563
Name:MCCULLOUGH, SHEILA G (OTR, CHT)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:G
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 LYE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9544
Mailing Address - Country:US
Mailing Address - Phone:802-558-3840
Mailing Address - Fax:
Practice Address - Street 1:4047 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6772
Practice Address - Country:US
Practice Address - Phone:802-558-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1569225X00000X
VT072-0000099225XH1200X
FLOT22351225XH1200X
MA3736225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008974Medicaid
VT4608590001Medicare NSC
VT1008974Medicaid